Robot– assisted radical cystectomy – surgical principles and evaluation of oncological, functional and complication outcomes
Authors:
S. I. Tyritzis; N. P. Wiklund
Published in:
Urol List 2014; 12(2): 40-44
Overview
In 2011, the EAU Guidelines were describing robot– assisted radical cystectomy (RARC) as an experimental procedure. Many centers were still in their learning curve and safe conclusions about the safety and efficacy of the procedure could not be drawn. In 2012, RARC was an option, but not proven. But, in 2013, RARC is a feasible and safe operation. It is advocated that RARC, being a highly complex surgery, consisting of multiple steps, should be performed by a devoted team of robotic surgeons, nurses and anesthetists, which are all experienced and have mastered the above steps. Literature data show that RARC trends to be superior in blood loss, hospitalization, and early and late complication rates. Additionally, there seems to be an advantage of the totally intracorporeal technique of urinary diversion compared to the extracorporeal technique. Moreover, recent long‑term oncological results show similar outcomes for RARC to open cystectomy. Until, high‑powered, randomized controlled trials with sufficient follow‑up will be published, open radical cystectomy remains the gold standard. In this review paper, we will describe our technique step by step, providing useful tips and tricks and present an update on multiple outcomes of the operation.
Key words:
robot-assisted radical cystectomy, urinary diversion, oncological and functional results
Sources
1. Stenzl A, Witjes JA, Compérat E et al. Guidelines on bladder cancer muscle- invasive and metastatic. European Association of Urology 2012. Available from: http:/ / www.uroweb.org/ gls/ pdf/ 07_Bladder%20Cancer_LR%20II.pdf.
2. Witjes JA, Compérat E, Cowan NC et al. Guidelines on muscle- invasive and metastatic bladder cancer. European Association of Urology 2013. Available from: http:/ / www.uroweb.org/ gls/ pdf/ 07_Bladder%20Cancer_LRV2.pdf.
3. Tyritzis SI, Hosseini A, Jonsson M et al. Robot- assisted intracorporeal formation of the ileal neobladder. J Endourol 2012; 26(12): 1570– 1575. doi: 10.1089/ end.2012.0424.
4. Collins JW, Tyritzis S, Nyberg T et al. Robot- assisted radical cystectomy: description of an evolved approach to radical cystectomy. Eur Urol 2013; 64(4): 654– 663. doi: 10.1016/ j.eururo.2013.05.020.
5. Cerantola Y, Valerio M, Persson B et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr 2013; 32(6): 879– 887. doi: 10.1016/ j.clnu.2013.09.014.
6. Li K, Lin T, Fan X et al. Systematic review and meta‑analysis of comparative studies reporting early outcomes after robot-assisted radical cystectomy versus open radical cystectomy. Cancer Treat Rev 2013; 39(6): 551– 560. doi: 10.1016/ j.ctrv.2012.11.007.
7. Snow- Lisy DC, Campbell SC, Gill IS et al. Robotic and laparoscopic radical cystectomy for bladder cancer: long‑term oncologic outcomes. Eur Urol 2014; 65(1): 193– 200. doi: 10.1016/ j.eururo.2013.08.021.
8. Tyritzis SI, Wiklund NP. Robot- assisted radical cystectomy. Comparison of outcomes with open surgery. EUT Congress News 2013; 2: 15.
9. Collins JW, Wiklund N. Totally intracorporeal robot- assisted radical cystectomy: optimizing total outcomes. BJU Int 2013. doi: 10.1111/ bju.12558.
10. Hautmann RE, Abol- Enein H, Davidsson T et al. ICUD- EAU International Consultation on Bladder Cancer 2012: Urinary diversion. Eur Urol 2013; 63(1): 67– 80. doi: 10.1016/ j.eururo.2012.08.050.
11. Tyritzis SI, Hosseini A, Collins J et al. Oncologic, functional, and complications outcomes of robot– assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol 2013; 64(5): 734– 741. doi: 10.1016/ j.eururo.2013.05.050.
12. Shabsigh A, Korets R, Vora KC et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009; 55(1): 164– 174. doi: 10.1016/ j.eururo.2008.07.031.
13. Johar RS, Hayn MH, Stegemann AP et al. Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2013; 64(1): 52– 57. doi: 10.1016/ j.eururo.2013.01.010.
14. Styn NR, Montgomery JS, Wood DP et al. Matched comparison of robotic- assisted and open radical cystectomy. Urology 2012; 79(6): 1303– 1308. doi: 10.1016/ j.urology.2012.01.055.
15. Yuh BE, Nazmy M, Ruel NH et al. Standardized analysis of frequency and severity of complications after robot- assisted radical cystectomy. Eur Urol 2012; 62(5): 806– 813. doi: 10.1016/ j.eururo.2012.06.007.
16. Nix J, Smith A, Kurpad R et al. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 2010; 57(2): 196– 201. doi: 10.1016/ j.eururo.2009.10.024.
17. Parekh DJ, Messer J, Fitzgerald J et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol 2013; 189(2): 474– 479. doi: 10.1016/ j.juro.2012.09.077.
18. Ahmed K, Khan SA, Hayn MH et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot- assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2014; 65(2): 340– 347. doi: 10.1016/ j.eururo.2013.09.042.
19. Wang GJ, Barocas DA, Raman JD et al. Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy. BJU Int 2008; 101(1): 89– 93.
20. Ng CK, Kauffman EC, Lee MM et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 2010; 57(2): 274– 281. doi: 10.1016/ j.eururo.2009.06.001.
21. Gondo T, Yoshioka K, Nakagami Y et al. Robotic versus open radical cystectomy: prospective comparison of perioperative and pathologic outcomes in Japan. Jpn J Clin Oncol 2012; 42(7): 625– 631. doi: 10.1093/ jjco/ hys062.
22. Khan MS, Challacombe B, Elhage O et al. A dual– centre, cohort comparison of open, laparoscopic and robotic- assisted radical cystectomy. Int J Clin Pract 2012; 66(7): 656– 662. doi: 10.1111/ j.1742‑ 1241.2011.02888.x.
23. Sung HH, Ahn JS, Seo SI et al. A comparison of early complications between open and robot- assisted radical cystectomy. J Endourol 2012; 26(6): 670– 675. doi: 10.1089/ end.2011.0372.
24. Richards KA, Kader AK, Otto R et al. Is robot-assisted radical cystectomy justified in the elderly? A comparison of robotic versus open radical cystectomy for bladder cancer in elderly ≥75 years old. J Endourol 2012; 26(10): 1301– 1306. doi: 10.1089/ end.2012.0035.
25. Knox ML, El- Galley R, Busby JE. Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach. J Endourol 2013; 27(1): 40– 44. doi: 10.1089/end.2012.0168.
Labels
Paediatric urologist UrologyArticle was published in
Urological Journal
2014 Issue 2
Most read in this issue
- Active approach to prostate cancer detection – what is reasonable and what may cause harm
- Prostate cancer – from hormonal dependency to castration resistant cancer
- Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer
- Erectile dysfunction and its treatment – pharmacological and clinical profile of avanafil